The Strategic Use and Potential Demand for an HIV Vaccine in Southern Africa
HIV prevalence in Southern Africa is the highest in the world and the impact of HIV/AIDS in the region are devastating at all levels of society, including the wider economy. Government response has lagged behind the pace of the epidemic, but progra...
| Main Authors: | , |
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| Format: | Policy Research Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2014
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/2003/02/2160787/strategic-use-potential-demand-hiv-vaccine-southern-africa http://hdl.handle.net/10986/19153 |
| Summary: | HIV prevalence in Southern Africa is the
highest in the world and the impact of HIV/AIDS in the
region are devastating at all levels of society, including
the wider economy. Government response has lagged behind the
pace of the epidemic, but programs are now beginning to
focus on a broad range of interventions to combat its
further spread and to mitigate its impact. The authors
investigate the issues around the targeting of an eventual
HIV vaccine. There is at present no vaccine against HIV.
Although several candidates are in the trial stage, it is
not likely that a vaccine effective against the sub-type of
the virus prevalent in Southern Africa will be available for
10-15 years. When it is, it may be expensive, only partially
effective, and confer immunity for a limited period only.
Vaccination programs will need to make the best use of the
vaccine that is available and effective targeting will be
essential. The authors identify potential target groups for
a vaccine, and estimate how many individuals would be in
need of vaccination. They develop a method for estimating
how many cases of HIV infection are likely to be avoided for
each vaccinated individual. The cases avoided are of two
kinds: primary-the individual case that might have occurred
in people who are vaccinated, and secondary-the number of
people that the vaccinated individual would otherwise have
caused to become infected. Both of these depend on
assumptions about the efficacy and duration of vaccine
protection and the extent and nature of sexual risk behavior
in the population groups. The authors distinguish between
the HIV cases averted per vaccination and the cases averted
per 100 recruits into a vaccination program. The cases
averted per 100 recruits is used to develop a priority
ranking of the identified population groups for vaccination.
The authors discuss the issue of ease of access to those
groups and how the differential costs would affect the
vaccination strategy. They conclude that an expensive
vaccine should be administered to commercial sex workers
first, while an inexpensive vaccine would be better
administered first to general population groups, in
particular, schoolchildren. The authors conclude with a
discussion of current levels of public and private
expenditure on HIV prevention and treatment, and the
implications for an assessment of the willingness to pay for
an eventual HIV vaccine. |
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